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A Muscular Response to Diabetes

A specialist weighs in on actions you can take after diagnosis

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More than half of the Americans who will be diagnosed with diabetes this year are between ages 45 and 64. When it comes to managing your long-term health, how you act shortly after diagnosis is critical, says Medha N. Munshi, M.D., director of the Geriatric Diabetes Program at the Joslin Diabetes Center in Boston.

Q: OK, let’s say I’m 60 and in relatively good health, but diabetes has entered my life. Should I, as a matter of course, see a specialist?

A: It’s OK to stay with your primary care physician. At this stage, however, what’s really important is to adopt lifestyle changes, specifically regarding diet and exercise. Many times the primary care setting doesn’t allow for counseling with a dietitian and an exercise physiologist. I often see people who were diagnosed 10, 15, 20 years ago but never had that counseling session, and as a consequence, they don’t have appropriate knowledge and understanding of how to make these changes. Diabetes is not like high blood pressure or cholesterol, where you take a pill and then things are under control. You have to make changes to your lifestyle.

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"Even a 5 to 7 percent weight loss lessens the risk of developing diabetes if you have prediabetes." 

Medha N. Munshi, M.D., director of the Geriatric Diabetes Program at the Joslin Diabetes Center in Boston.

Q: So, what can those in their 50s and 60s do to protect themselves from diabetes complications as they age?

A: There is plenty of evidence that if you’re in the prediabetes range and if you’re eating healthy and exercising, then your chances of developing diabetes decrease significantly — and if you have diabetes, your chances of developing complications decrease. The key is to combine diet modification with exercise. Even a 5 to 7 percent weight loss lessens the risk of developing diabetes if you have prediabetes. Exercise, though, is critical. If you try to lose weight simply through dieting, then you’re losing not just fat but also muscle, which is unhealthy.

Q: Why is losing muscle particularly bad for people with diabetes?

A: Muscle loss with aging is called sarcopenia, and it’s a natural part of the aging process. As you get older, it’s not only hard to put on muscle; it’s hard to maintain muscle. If you restrict calories without adding exercise, there is a further decline in muscle mass. Low muscle mass causes an increase in insulin resistance, which translates to increased glucose levels. In addition, low muscle mass can make you feel tired, cause balance problems and increase the risk of falls. 

Q: What is the best way to treat diabetes?

A: A patient needs to work with his or her physician to find the right approach. Often I’ll see a diabetic patient who’s gone in for surgery, whether hip replacement or heart bypass. The person comes out on four insulin injections a day because the doctor overseeing the care during hospitalization was treating the blood sugar aggressively. Then that level of treatment sticks after recovery, even if the amount of medication isn’t necessary. That puts the patient at a high risk of hypoglycemia — low blood sugar — which can lead to bad outcomes. Sometimes, when there are a number of other health issues involved, a treatment plan may not be the perfect regimen for diabetes, but it could be the best regimen for the patient.

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